22 year old gentleman with chronic headache and dizziness.
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- the pineal region shows a lobulated soft tissue mass lesion, it measures about 2.9 X 2.7 X 2.7 cm in its main diameters.
- the lesion shows mildly hypointense T1 and hyperintense T2 / FLAIR signal, with inhomogenous post-contrast enhancement.
- the lesion shows mild restricted diffusion.
- a suspected small signal void focus is seen at its peripheral anterior aspect of the lesion (which was evident on CT study that was available with the patient).
- the lesion is seen compressing the superior portion of the cerebral aqueduct with moderate supratentorial hydrocephalus as well as transependymal CSF permeation.
- mild downward herniation of the cerebellar tonsils is noted.
MR spectroscopy of the lesion shows:
- elevation of the choline and lipid lactate peaks.
- depression of the neural markers; N-acetyl aspartate (NAA) and creatine (Cr).
- prominent glutamate and taurine peaks at 3.4 ppm with shot TE signal voxel MR spectroscopy.
Pineal body malignant mass lesion; pineoblastoma with moderate supratentorial hydrocephalus. The differential diagnosis is a germinoma which gives typical MRI appearance, yet with the calcification is typically central in germinoma and peripheral in pineoblastoma.